Provider Demographics
NPI:1932556750
Name:DIVINE MERCY HOME HEALTH, LLC.
Entity Type:Organization
Organization Name:DIVINE MERCY HOME HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REALINO
Authorized Official - Middle Name:LEOPOLDO
Authorized Official - Last Name:GURDIEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:847-668-4494
Mailing Address - Street 1:4900 SW GRIFFITH DR STE 261
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4648
Mailing Address - Country:US
Mailing Address - Phone:503-608-7717
Mailing Address - Fax:503-608-7718
Practice Address - Street 1:4900 SW GRIFFITH DR STE 261
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4648
Practice Address - Country:US
Practice Address - Phone:503-608-7717
Practice Address - Fax:506-608-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health